End-of-Life Decisions: Telling Your Vet No

“My dog needs to be put to sleep,” said the voice on the other end of the phone. “She has cancer, and we consulted with an oncologist, and we had an ultrasound done.” Before I could say a word, he continued: “We already asked about chemotherapy, and they said it would be $5,000, and after going through it with my cat already, I’m not sure I can do it again.” He paused for breath, waiting for my response.

“I’m so sorry about your dog,” I responded. “What is her name?” The man hadn’t even had a chance to tell me that, so rushed was he to convince me that this was the right decision for his family before I could suggest another course of treatment. It happens a lot in this line of work.

I never truly understood how often clients feel put on the defensive about their choices for terminally ill pets until I began my work as a hospice and home euthanasia veterinarian. I don’t believe it’s intentional on the part of most veterinarians, but the truth remains that there can be a big gap between veterinarians and owners when it comes to communicating about terminal disease and end-of-life care.

Why There May Be a Disconnect

Veterinarians are trained to cure disease. When you present a pet to us with a problem, our goals are simple: try to diagnose the problem and help you solve it. This is what we are prepared to do every day, and we do it well. In the past couple of decades, it has gotten even better. Between increased specialization and improved technology, pets can enjoy a level of care that rivals our own in many ways.

But not every pet owner wants to battle terminal disease to the bitter end. This amazing level of care comes at a financial cost, which may be out of reach for many pet owners. And in addition to the cost of treating terminal illness, many owners simply do not want to put their pet through the stress of aggressive therapy that will not eliminate the disease.

The most aggressive therapy does not always equal the best course of treatment, and that decision can only be made by an informed owner who has all the necessary information in front of him. It’s a vet’s job to provide information, to empower you to make choices right for your family and your pet, including how to keep your pet as comfortable as possible through a terminal disease when the family elects not to pursue treatment.

Too often, pet owners feel like they are unable to say, “I don’t want to do that.” They may be concerned about appearing uncaring, embarrassed to say they really can’t afford thousands in veterinary bills, or they just may not be aware that palliative treatment is a valid alternative. Many veterinarians are gradually getting better at offering hospice care and palliative treatments to clients, but the field is still relatively new, and all too often, owners are unaware it exists.

So how can owners be prepared for a conversation about end-of-life issues without walking away feeling guilty?

1. Take the time you need to understand what is happening.

The diagnosis of a terminal disease can be shocking, especially when it comes out of the blue: a limping dog who has not a sprained leg but bone cancer, for example. If this is not an emergency situation, don’t feel as though you need to make any decisions during this initial consultation. It will take some time to digest. Many owners find going home and taking time to research and talk leads to a much more constructive conversation the next day.